Mild anemia is normal during pregnancy due to the increase in blood volume however, higher levels can be risky for the infant during later stages of the pregnancy.
Important information MC cause of Anemia in pregnancy in India: Nutritional Anemia
Causes of Anemia
1. Decreased Production
Iron Deficiency Anemia
Megaloblastic Anemia
Folic Acid Deficiency Anemia
2.Increased Lysis
Hemolytic Anemia
Chronic Blood Loss
Definitions of Anemia
WHO → Hb → < 11 gm%
CDC → Hb → < 11 gm% or Hb → < 10.5 gm% in 3rd trimester
Mild → Hb → 10 -11 gm%
Moderate → Hb → 7-10 gm%
Severe → Hb → < 4 gm %
Iron Deficiency Anemia
Iron Requirement in Pregnancy
1000 mg elemental Iron [4-6 mg/ day x 280 = 1120 mg]: cannot be met diet alone
500 mg - For Hb expansion
300 mg - For fetus, placenta
200 mg - Wasted
Management
100 mg / day elemental Iron Tab in Ⓝ pregnancy
200 mg / day elemental Iron in mild to moderate anemia
Oral Iron supplementation forms like Fe Sulphate, Fe Ascorbate, Carbonyl iron are all better Absorbable forms
Every patient with anemia must be dewormed with MEBENDAZOLE (100 mg Tab BD x 3 Days)
Injectable Preparations: The rate of increase of Hb with oral and injectable is same, thus the only indication for injectable iron use is Intolerance or Malabsorption. Stop oral Iron at the time of giving injectables as both use same gut receptors for absorption. Injectable forms available are
Fe Dextran (IM/IV)
Fe Sorbitol [IM]
Fe Sucrose (iv): No anaphylaxis (no test dose is given)
Rate of rise of Hb with Oral & Injectable preparation is same [1 gm% Hb rise over 2 ½ - 3 wks]
Important information
Requirement of Iron
2.21 x wt in kg x (Targeted Hb – Pt Hb) + 1000 mg (for stores)
≅ 200 mg / gm% Hb deficiency
Requirement of Blood for Rx of Anemia in pregnancy
Indications: Hb: <7 gm% or patient is severely anemic later in pregnancy
Whole blood increases Hb by 0.8 - 0.9 gm%
Packed cells increase Hb by 0.8 - 0.9 gm %. This however gives lesser volume load than whole blood, thus preferred over whole blood.
Indices in Fe deficiency
Serum Ferritin
1st parameter to change
Ⓝ: 40-160 ng/ml
IDA: < 20 ng/ml
Hb: ↓
MCV: ↓
MCH: ↓
Serum total Iron: < 50 µg/dl
Total Iron binding capacity: > 400 µg/dl
Red cell distribution width (RDW): ↑
Thalassemia Indices
RDW: Normal
MCH: < 27 pg [Normal – 29 pg]
Hb: Normal
MCV/RBC: < 13 [Mentzer Index)
On HPLC: HbA2 levels > 3.5
Do not overload patient with iron
Peripheral smear of both IDA Thalassemia shows: Microcytic, Hypochromic, Anemia
Megaloblastic Anemia
Causes
1. Folic Acid deficiency
↑ demand
↓ Supply
Malabsorption
Intestinal Sx or resection
2. Vit B12 Deficiency
↓ Absorption: malabsorption syndromes
↓ Intrinsic factor
Achlorhydria
Features
Slow onset
Hb ↓
MCV: > 100 fL
Requirement of folic acid: 0.4 to 0.5 mg/day
Supplementation of Folic acid: 5 mg / day in Megaloblastic anemia
Vitamin B12 (Cobalamin) requirement is only met by non veg diet so Inj. cynocobalamin can be given in vegetarian females
Nutritional Anemia / Dimorphic Anemia
IDA (Microcytic hypochromic RBCs) + Megaloblastic Anemia (Hypersegmented neutrophils)
This is the most common type of anemia in pregnant women in India
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